The establishment of gastroesophageal reflux disease (GERD) in patients with bronchial asthma – The role of reflex and reflux mechanisms

The aim of the study was to investigate the prevalence of GERD, proximal gastroesophageal reflux (GER), and esophago-bronchial reflex (EBR) in patients with asthma.

Patients, methods: 30 consecutive patients (M/F 9/21) with recent diagnosis of bronchial asthma were prospectively invited for the evaluation of GERD. 12 of them refused the participation. The enrolled 18 patients were submitted to GERD symptom analysis, upper gastrointestinal endoscopy, esophageal manometry, and Bernstein test. Proximal GER was established by double channel intraesophageal pH monitoring. The presence of EBR was studied by combined esophageal acid (0.1N HCl) perfusion and metacholin test.

Results: Typical symptoms of GERD, such as heartburn and acid regurgitation were reported in 14 and 12 cases. Bernstein test reproduced heartburn in 8 patients, but failed to provoke either respiratory symptoms or significant changes in the respiratory function when it was applied alone. Proximal GER was detected in 14/18 cases, and the EBR was present simultaneously in 8 of them. The reflex was present alone in 1 patient. The endoscopic evaluation showed equal occurrence (9/18) of erosive and non-erosive forms of GERD. Furthermore the presence of esophageal erosions appeared to be independent of both proximal reflux and EBR.

Conclusion: The frequent study refusal of the invited patients despite of their detailed information can be explained by the lack of gastrointestinal symptoms. The high prevalence of proximal GER indicates that this mechanism has an important role in the development bronchial hyperreactivity. The combination of metacholin test with esophageal acid perfusion is a valuable tool for the establishment of EBR, which was detected in half of the patients.